Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States and will account for approximately 10% of cancer mortality in 1999. Data from the NCI Surveillance, Epidemiology, and End Results (SEER) Program, during the years 1990-95, report that the mortality rate from CRC for blacks was 23.3/100,000 compared to 17.5/100,000 for whites. The black/white disparity in mortality rate has been attributed in part to more advanced stage of disease at diagnosis among blacks and decreased access to care. Failure to receive standard and effective therapy may also account for the disparities in survival. There is little known about the predictors of late stage at diagnosis, as well as barriers to the receipt of appropriate primary treatment of colorectal cancer. Thus, this study proposes an in-depth examination of the interaction of the health care system with individual patient characteristics to provide potential explanation for the disparities in outcomes for colorectal cancer between blacks and whites. The specific aims of this study are: 1) To refine and evaluate a taxonomy for opportunities to make an early diagnosis of CRC. 2) To develop patient self-report and medical record review instruments to evaluate systematically which opportunities have taken place and which have been missed, and the reasons for missed opportunities. 3) To recruit a cohort of black and white patients who are newly diagnosed with CRC. 4) To use an interview administered survey and medical record review of newly diagnosed patients with CRC to assess which opportunities for early diagnosis have taken place and which were missed. 5) To use information from the patient survey and medical record review to examine the distributions of missed opportunities for early diagnosis, particularly as a function of race. 6) To use information from the patient surveys and medical record review to examine differences in stage adjusted treatment for newly diagnosed patients with CRC, particularly as a function of race.